Excessive Sweating (Hyperhidrosis)

Hyperhidrosis is a common condition where a person sweats excessively which is much more than the body needs in order to regulate its temperature.

Excessive Sweating doesn’t usually pose a serious threat to a person’s health but it can be embarrassing and distressing. The inconvenience of it can also have a negative impact on your quality of life. There is no set way of defining Excessive Sweating but if sweating is interfering with your daily life and normal activities, you may have Hyperhidrosis.

Hyperhidrosis is defined as sweating more than is needed to regulate the body’s temperature.

In cases of focal Hyperhidrosis (where only certain parts of the body are affected), the most common parts of the body to be affected are your:

Armpits

Palms of your hands

Soles of your feet

Face and chest

Some people may only have one area of their body affected by Hyperhidrosis whereas for others several areas can be affected. Both sides of the body are usually affected equally – for example, both of the feet or both hands.

Most people with Focal Hyperhidrosis have at least one episode of Excessive Sweating a week. The frequency of sweating in people with Secondary Hyperhidrosis (where the condition has an underlying cause) will depend on what the underlying cause is.

There are no guidelines to determine what constitutes “normal sweating”, but if you feel that you sweat excessively and it has started to interfere with your everyday daily activities and social life, you may have Hyperhidrosis.

For example, you may have Hyperhidrosis if:

You are reluctant to shake hands with someone or have other physical contact due to feeling self-conscious about your sweating.

You are reluctant to take part in activities such as dancing or exercise for fear that they will make your sweating worse.

You are finding that Excessive Sweating is interfering with your job – for example, you have difficulty holding tools or using a computer keyboard.

You are having problems with normal daily activities such as driving.

Your attempt to cope with the sweating takes up a significant amount of time – for example, you need to have frequent daily showers and change your clothes two or three times a day.

You become socially withdrawn and self-conscious.

Causes of Hyperhidrosis

Primary Hyperhidrosis

Most experts believe that Primary Hyperhidrosis is caused by problems with the Sympathetic Nervous System.

The sympathetic Nervous System

The Sympathetic Nervous System controls most of your body’s functions that do not require conscious thought, such as movement of food through your body and the movement of urine out of your kidneys and into your bladder.

The Sympathetic Nervous System uses sweat like a thermostat. If it senses that you are getting too hot, it will send a signal from your brain to the millions of sweat glands in your body to produce sweat. The sweat cools on your skin and reduces the temperature of your body.

Sweat glands, known as the Eccrine Glands, appear to be involved in Hyperhidrosis. Eccrine Glands are present in the greatest numbers on your armpits, hands, feet and face, which may explain why these areas are often affected by Hyperhidrosis.

It is thought that in cases of Primary Hyperhydrosis, there is a problem with the part of the brain that regulates the sweating process, that results in the brain sending signals to the Eccrine Glands, even though there is no need to cool the body.

Hyperhidrosis in families

Cases of Primary Hyperhidrosis can run in families, with 1 in 4 of all those affected having a close family relative who was (or is) affected by the condition. This would suggest that a genetic mutation is responsible.

A genetic mutation is where the instructions that are carried in all living cells become scrambled in some way, which can disrupt the normal workings of the body. Some genetic mutations can be passed down from parents to their children.

Secondary Hyperhidrosis

Common causes of Secondary Hyperhidrosis (where there is an underlying cause) include:

Menopause – when a woman’s monthly periods stop, usually around the age of 52

Over Active Thyroid Gland

Being drunk on alcohol or “high” on drugs – particularly stimulants such as cocaine or ecstasy

Withdrawing from alcohol or drugs (in people who have become addicted to them)

Some types of medications can also cause Excessive Sweating in some people. For example:

Anti-depressants – in particular, an antidepressant called Venlafaxine

Tamoxifen – which is often used to treat Breast Cancer

Gonadotropin-releasing hormone antagonist – which is used to treat Infertility in women and Prostate Cancer in men

Less common causes of Secondary Hyperhidrosis include:

Some types of infection, such as HIV or Tuberculosis (TB)

Parkinson’s Disease – a condition that affects the way the brain co-ordinates body movements

Disorders that develop inside Blood Cells or Bone Marrow, such as Leukaemiaor Lymphoma (both of which are Cancers of the White Blood Cells)

Diagnosing Hyperhidrosis

If you sweat excessively, it is likely that your GP will arrange blood and urine tests to help determine whether there is an underlying medical condition that is causing it.

Your GP will ask you about the pattern of your symptoms, such as whether you sweat at night, which is unusual in cases of Primary Hyperhidrosis (where there is no obvious cause), and whether your sweating only affects a specific part of your body (focal) or all of your body (generalised).

Focal Hyperhidrosis usually has no underlying cause (Primary Hyperhidrosis), whereas generalised or secondary Hyperhidrosis tends to occur as a result of another underlying medical condition.

A confident diagnosis of Primary Hyperhidrosis can usually be made if:

No underlying cause has been found.

You have at least one episode of Excessive Sweating a week.

Only specific parts of your body (rather than your whole body) are affected.

Both of the affected body parts, such as both armpits or both hands, are excessively sweaty.

You do not have night sweats.

Treating Hyperhidrosis

Lifestyle changes

Changing your lifestyle and daily activities cannot cure Primary Hyperhidrosis, but it can improve your symptoms and make you feel more self-confident.

The advice listed below may help to improve your symptoms.

Avoid known triggers that make your sweating worse, such as spicy foods and alcohol.

Wearing black or white clothing can help to minimise the signs of sweating.

Armpit shields can help to absorb excessive sweat and protect your clothes.

Wear socks that absorb moisture, such as thick, soft socks that are made of natural fibres, or sports socks that are designed to absorb moisture. Avoid wearing socks that are made out of synthetic (man-made) materials and change your socks at least twice a day.

Buy shoes that are made of leather, canvas or mesh, rather than synthetic material.

Prescription Antiperspirant

If a regular Antiperspirant has failed to control your sweating, your GP may prescribe a more powerful one for you. Aluminium chloride is often used to treat Hyperhidrosis, and it works by plugging up the sweat glands.

You will need to apply Aluminium Chloride at night just before you go to sleep. To avoid irritation, make sure that the area of skin you apply it to is dry before you apply it. You will need to wash off the Aluminium Chloride in the morning.

If you apply Aluminium Chloride to your face, be careful not to get any in your eyes. Men should avoid shaving 24 hours before and after applying Aluminium Chloride to their face.

The most common side effect of Aluminium Chloride is some mild skin irritation or itching and tingling at the site where it is applied. However, these types of side effects should pass quickly.

Iontophoresis

Iontophoresis is an effective treatment if you have Excessive Sweating that affects your hands or feet. It can also be used to treat armpits, although this is usually less effective.

If your hands and feet need treating, you place them in a bowl of water and a weak electric current is passed through the water.

If your armpits need treating, then a wet contact pad is placed against each armpit and then a current is then passed through the pad.

The current is thought to help block the sweat glands.

The treatment is not painful but the electric current can cause some mild, short-lived discomfort and skin irritation.

Each session of Iontophoresis lasts between 20 and 30 minutes and you will usually need to have two to four sessions a week. Your symptoms should begin to improve after a week or two, after which further treatment will be required at one-to-four week intervals, depending on how severe your symptoms are.

Iontophoresis has proved to be effective in 80% to 90% of cases. However, you will need to make regular visits to your local clinic to receive treatment.

INJECTIONS

Surgery

Endoscopic Transthoracic Sympathectomy – ETS

Endoscopic Transthoracic Symathectomy (ETS) is a key-hole surgery technique that is 99% effective at curing Palmar Hyperhidrosis and, with a slight modification, can also cure Axillary Hyperhidrosis in 80% of people at the same time. The same technique, modified once again, can also be used for facial flushing, blushing or sweating – with a success rate of 70% for each side. It must be noted though, that there are now much better ways of treating Axillary Hyperhidrosis (armpit sweating).

Sweating in the hand is controlled by the Sympathetic Nervous System. This system is grouped together as a “chain” in the chest, on the spinal column.

Under a General Anaesthetic (GA), it is possible to put a keyhole telescope through a 1 cm incision in the armpit, to deflate the lung a little and to cut this chain. By doing this, the hand instantly becomes warmer and bone dry. If the axilla is being treated as well, removal of part of the chain can, in 4 out of 5 cases be effective at treating this.

As with all surgical procedures there are side effects and complications that patients and their relatives must be aware of before going through with this operation.

Risks of Endoscopic Transthoracic Sympathectomy

1 – Compensatory Hyperhidrosis

The body needs to lose heat and so, if the arms and head are treated by ETS, the sweat that should have come from these areas is re-distributed elsewhere. This re-distribution of sweating is called Compensatory Hyperhidrosis. It can be especially noticeable in the small of the back – and some people find this unbearable. Everybody gets Compensatory Hyperhidrosis – but only a few find it unbearable – recent research suggests over 85% of pateints are satisfied with the results of their ETS despite some increased sweating elsewhere.

2 – Damage to the Lung needing a chest drain

Rareley, in approximately 1 in 100 patients, the lung can be damaged during the surgery, leading to a tube called a “chest drain” having to be put in place for a couple of days to make sure that the lung re-inflates. Very rarely, the lung needs to be repaired after such an injury.

3 – Horner’s Syndrome

If too much of the chain is damaged, the face can become dry on the same side, the eye lid can droop a little and the eye itself can have a dilated pupil (Horner’s syndrome). This was quite common with the older styles of surgery where the chain was approached through the neck, or was destroyed by heating at ETS.

4 – Winging of the Scapula

There have been reports that the nerve to the muscle of the shoulder blade can be damaged leading to “winging” of the shoulder blade. This means that the shoulder blade moves out to the side and needs intensive physiotherapy to see if it can be brought back again.

5 – Injury to a major structure in the Chest

The chest houses some of the largest and most important structures in the body – particularly the Heart, the Great Blood Vessels and the Lungs. However, there is always a very small chance that one of these structures can be damaged. If this happens then the outcome depends on which structure is damaged and how severely.